天津市托幼机构3~6岁儿童超重和肥胖流行趋势调查及相关因素分析
发布时间：2019-05-22 18:08
【摘要】：目的了解2006~2014年天津市3~6岁儿童超重和肥胖的流行趋势,从个人、家庭和生活方式等方面探讨天津市儿童超重肥胖发生的影响因素,并进一步研究儿童肥胖与血脂、血糖、血尿酸的关系,为制定天津市3~6岁儿童超重肥胖预防和干预措施提供依据。方法1.2006~2014年,在天津市46所市级监测幼儿园收集145078例3~6岁儿童的体检信息,包括儿童身高、体重,计算体重指数(body mass index,BMI)Z值(Z-scores),分析儿童生长发育的长期变化趋势。2.于2015年采用整群抽样的方法,根据儿童保健手册统一编码,回顾性研究2013年和2014年共计1286例儿童的体检指标,采用卡方检验、Logistic回归、重复测量方差分析、t检验分析不同儿童身高、体重、BMI及超重肥胖构成情况随年龄的变化趋势,以及在不同年龄、性别间的差异性。3.对2015年1286例在园儿童进行生长发育和健康状况调查及体格检查。采用方差分析、Logistic回归探讨天津市儿童超重肥胖发生的影响因素。4.于2015年采用整群抽样的方法,对抽取3305例儿童进行空腹血清总胆固醇、甘油三酯、血糖、血尿酸检测,采用t检验、方差分析及Logistic回归分析方法探讨儿童肥胖与血脂、血糖、血尿酸的关系。结果1.从2006年到2014年,天津市3~6岁儿童年龄别身高Z值显著增长,从0.34增长到0.54;儿童年龄别体重Z值保持稳定;年龄别BMI Z值从0.40下降到0.23。儿童超重率从2006年的23.4%下降到20.7%,肥胖率从2006年的7.0%增长到2010年的7.9%,从2010年到2014年保持稳定。男孩的超重和肥胖率远高于女孩。3~6岁儿童肥胖率随着年龄急剧增长,从3岁的4.9%增长到6岁的11.6%,增长了2.4倍。2.2013~2015年纵向研究显示,3年间男童体重、身高和BMI均高于女童(P0.05),2014和2015年6岁童身高、体重高于5岁童(P0.05)。2013年6岁童身高、体重和BMI高于5岁童,差异有统计学意义(P0.05);6岁童的体重变化高于5岁儿童,变化显著差异有统计学意义(P0.05),6岁更高(P0.05);BMI变化趋势,差异无统计学意义(P0.05)。三年不同年龄儿童的肥胖和超重构成差异无统计学意义(p0.05)。2013年不同性别的肥胖和超重构成差异无统计学意义(p0.05);2014年和2015年男童的肥胖、超重构成高于女童(p0.05)。3.在1286名儿童中2013年进入队列的体重正常儿童1072名,在2015年肥胖发生率为4.6%,超重发生率为7.2%,超重或肥胖合计发生率为11.8%。logistic回归分析显示男孩、人工喂养、看屏幕(包括电视、手机、电脑)时间较长、吃饭时间较快是天津市托幼机构5~6岁儿童肥胖的危险因素(p0.05)。父母文化程度、平均每天睡眠时间、从托幼机构回家后是否吃主食,与儿童肥胖的发生无关联(p0.05)。4.不同性别儿童,血清总胆固醇异常率差异有统计学意义(p0.05),男童低于女童。不同年龄儿童,3岁童血脂异常率及血清总胆固醇异常率高于其他年龄组,差异有统计学意义(p0.05)。不同体型儿童血脂异常率、血清总胆固醇异常率差异无统计学意义(p0.05)。但肥胖儿童血清甘油三酯异常率远高于正常儿童(p0.05)。不同性别儿童,血清总胆固醇及甘油三酯水平差异有统计学意义(p0.05),女童高于男童。不同年龄阶段的儿童,血清总胆固醇差异有统计学意义(p0.05)。不同体型的儿童,血清甘油三酯水平差异有统计学意义(p0.05)。在不同性别、年龄及体型的3~6岁儿童中,血糖异常率差异无统计学意义(p0.05)。不同性别的3~6岁儿童血糖水平差异有统计学意义(p0.05),男孩平均血糖水平高于女孩。不同年龄阶段的儿童,血糖水平差异有统计学意义(p0.05),随年龄的增长,平均血糖水平逐渐增高。不同体型的儿童,血糖水平差异有统计学意义(p0.05),肥胖儿童的平均血糖水平高于正常体型儿童。血尿酸异常率在不同年龄及性别儿童间差异无统计学意义(p0.05),但不同体型儿童的血尿酸异常率差异有统计学意义(p0.05),肥胖儿童的水平要高于正常体型儿童。此外,随年龄增长,血尿酸水平呈上升趋势,但不同年龄组间差异无统计学意义(p0.05)。而不同性别、体型儿童的血尿酸水平差异有统计学意义(p0.05),男孩血尿酸水平高于女孩,肥胖儿童血尿酸水平高于正常体型儿童。血清总胆固醇、甘油三酯、血尿酸与超重或肥胖的发生有关联(p0.05),血糖与超重或肥胖的发生无相关性(p0.05)。结论从2006年到2014年,天津市3~6岁儿童的超重患病率总体呈缓慢下降趋势,肥胖患病率呈上升趋势,以6岁儿童最为明显。超重及肥胖的患病率有性别差异,男童高于女童,不同性别间变化趋势较为一致。儿童超重和肥胖的发生受时间和性别双重因素交互作用的影响。性别男、人工喂养、看屏幕(包括电视、手机、电脑)时间较长、吃饭时间较快是5~6岁儿童肥胖的危险因素;出生后4个月内混合喂养是儿童肥胖的保护性因素。肥胖儿童的血脂、血糖、血尿酸水平高于正常体型儿童,且随年龄增长水平呈增高趋势。儿童的超重和肥胖受外界因素影响,应重视3~6岁儿童超重肥胖的预防及健康教育,以降低该年龄段儿童超重肥胖患病率;儿童家长及各医疗保健部门应适时监测儿童体格发育状况,及时发现超重肥胖状况,针对儿童这一特殊群体予以有效干预。
[Abstract]:Objective To study the prevalence of overweight and obesity in children from 3 to 6 years of age in Tianjin from 2006 to 2014, and to explore the factors affecting the incidence of overweight and obesity in Tianjin from the aspects of personal, family and lifestyle, and to further study the relationship between the obesity of children and blood fat, blood sugar and blood uric acid. In ord to provide that basis for the development of the prevention and intervention measure of overweight and obesity in children between 3 and 6 years of age in Tianjin. Methods From 2006 to 2014,145078 children aged from 3 to 6 years of age were collected in the 46 municipal monitoring kindergartens in Tianjin, including the height and weight of the child, the body mass index (BMI) and the Z-scan, and the long-term trend of the growth and development of the children was analyzed. By means of cluster sampling in 2015, according to the uniform coding of the children's health care manual, a retrospective study of 1286 children's physical examination indexes in 2013 and 2014 was carried out. The chi-square test, logistic regression, repeated measures of variance analysis and t-test were used to analyze the height and weight of different children. The composition of BMI and overweight was the trend of age, and the difference in age and sex. The development and health status of 1286 children in the park were investigated and the physical examination was carried out in 1286 in 2015. An analysis of variance and logistic regression were used to study the factors affecting the incidence of overweight and obesity in Tianjin. The total cholesterol, triglyceride, blood sugar and blood uric acid in 3305 children were tested by cluster sampling in 2015, and the relationship of obesity with blood fat, blood sugar and blood uric acid was discussed by t-test, variance analysis and logistic regression analysis. Results 1. From 2006 to 2014, the Z-value of the children in Tianjin from 3 to 6 years of age increased significantly, from 0.34 to 0.54; the Z value of the age of the child remained stable; the value of the age-specific BMI Z decreased from 0.40 to 0.23. The rate of overweight of children fell from 23.4 per cent in 2006 to 20.7 per cent, and the rate of obesity increased from 7.0 per cent in 2006 to 7.9 per cent in 2010 and remained stable from 2010 to 2014. The rate of overweight and obesity of boys was much higher than that of girls. The rate of obesity in children between 3 and 6 years increased with age, from 4.9% in the age of 3 to 11.6% in the 6-year-old, increasing by 2.4 times. The vertical study from 2013 to 2015 showed that the weight, height and BMI of boys in the three years were higher than that of the girl (P0.05), and the height of the 6-year-old boys in 2014 and 2015. The body weight was higher than that of the 5-year-old (P0.05). The height, body weight and BMI of the 6-year-old children were higher than that of the 5-year-old children (P0.05). The change of the weight of the 6-year-old children was higher than that of the 5-year-old children (P0.05). The change of the body weight of the 6-year-old children was higher than that of the 5-year-old (P0.05). The change of BMI was higher (P0.05). The difference was not significant (P0.05). The difference of obesity and overweight in children with different age in three years was not statistically significant (p0.05). The difference of obesity and overweight in different sexes in 2013 was not statistically significant (p0.05); the obesity and overweight of boys in 2014 and 2015 were higher than that of girls (p0.05). Of the 1286 children who entered the cohort in 2013,1072 were normal, the incidence of obesity was 4.6% in 2015, the incidence of overweight was 7.2%, and the total incidence of overweight or obesity was 11.8%. Logistic regression analysis showed that the time of the boy, the artificial feeding, the viewing screen (including the TV, the mobile phone, the computer) was long, The risk factors of the obesity of children between 5 and 6 years of age in the kindergartens in Tianjin are the risk factors of the obesity of children between 5 and 6 years old in Tianjin (p0.05). The degree of parental culture, the average daily sleep time, whether to eat the staple food from the children's children's home and the occurrence of obesity in the children (p0.05). The difference of abnormal rate of serum total cholesterol in children with different sex was statistically significant (p0.05), and boys were lower than that of girls. The abnormal rate of blood lipid and serum total cholesterol in children with different ages was higher than that of other age groups (p0.05). There was no statistical difference between the abnormal rate of blood lipid and the abnormal rate of serum total cholesterol (p0.05). The abnormal rate of serum triglyceride in obese children was much higher than that of normal children (p0.05). The difference of serum total cholesterol and triglyceride in children with different sex was statistically significant (p0.05), and girls were higher than that of boys. The difference of serum total cholesterol in children with different age groups was statistically significant (p0.05). There was a significant difference in serum triglyceride levels in children with different body size (p0.05). There was no significant difference in the rate of blood glucose (p0.05) among the 3-6-year-old children with different sex, age and body size. The difference of blood glucose levels between 3 and 6 years of age in different sexes was statistically significant (p0.05), and the average blood sugar level of boys was higher than that of girls. The difference of blood glucose level in children with different age groups was statistically significant (p0.05), with the increase of age and the increase of the average blood glucose level. The difference of blood glucose level in children with different body size was statistically significant (p0.05), and the average blood sugar level of obese children was higher than that of normal children. The abnormal rate of uric acid in children with different age and sex was not statistically significant (p0.05), but there was a significant difference in the rate of blood uric acid in different types of children (p0.05), and the level of obese children was higher than that of normal children. In addition, with the increase of age, the level of serum uric acid was on the rise, but there was no significant difference between the age group and the age group (p0.05). The levels of serum uric acid in children with different sex and body type were statistically significant (p0.05). The level of serum uric acid in boys was higher than that of girls, and the level of blood uric acid in obese children was higher than that of normal children. Serum total cholesterol, triglyceride, and blood uric acid were associated with the occurrence of overweight or obesity (p0.05), and there was no correlation between blood glucose and overweight or obesity (p0.05). Conclusion From 2006 to 2014, the prevalence of overweight in Tianjin from 3 to 6 years of age is generally decreasing, and the prevalence of obesity is on the rise, with the most obvious in 6-year-old children. There was a gender difference in the prevalence of overweight and obesity. The incidence of overweight and obesity in children is influenced by the interaction of time and gender. Sex male, artificial feeding, viewing screen (including television, mobile phone, computer) is long, and the time for eating is the risk factor of the obesity of children between 5 and 6 years; the mixed feeding within 4 months after birth is a protective factor for children's obesity. The level of blood lipid, blood sugar and blood uric acid in obese children was higher than that of normal children, and the level of blood glucose increased with age. The overweight and obesity of children are affected by external factors, and the prevention and health education of overweight and obesity among children aged 3 to 6 should be paid attention to, so as to reduce the prevalence of overweight and obesity of children in the age group; and the parents and the health care departments of the children shall timely monitor the physical development of the children and find out the overweight and obesity situation in time. Effective intervention is given to the particular group of children.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R723.14
本文编号：2483127
[Abstract]:Objective To study the prevalence of overweight and obesity in children from 3 to 6 years of age in Tianjin from 2006 to 2014, and to explore the factors affecting the incidence of overweight and obesity in Tianjin from the aspects of personal, family and lifestyle, and to further study the relationship between the obesity of children and blood fat, blood sugar and blood uric acid. In ord to provide that basis for the development of the prevention and intervention measure of overweight and obesity in children between 3 and 6 years of age in Tianjin. Methods From 2006 to 2014,145078 children aged from 3 to 6 years of age were collected in the 46 municipal monitoring kindergartens in Tianjin, including the height and weight of the child, the body mass index (BMI) and the Z-scan, and the long-term trend of the growth and development of the children was analyzed. By means of cluster sampling in 2015, according to the uniform coding of the children's health care manual, a retrospective study of 1286 children's physical examination indexes in 2013 and 2014 was carried out. The chi-square test, logistic regression, repeated measures of variance analysis and t-test were used to analyze the height and weight of different children. The composition of BMI and overweight was the trend of age, and the difference in age and sex. The development and health status of 1286 children in the park were investigated and the physical examination was carried out in 1286 in 2015. An analysis of variance and logistic regression were used to study the factors affecting the incidence of overweight and obesity in Tianjin. The total cholesterol, triglyceride, blood sugar and blood uric acid in 3305 children were tested by cluster sampling in 2015, and the relationship of obesity with blood fat, blood sugar and blood uric acid was discussed by t-test, variance analysis and logistic regression analysis. Results 1. From 2006 to 2014, the Z-value of the children in Tianjin from 3 to 6 years of age increased significantly, from 0.34 to 0.54; the Z value of the age of the child remained stable; the value of the age-specific BMI Z decreased from 0.40 to 0.23. The rate of overweight of children fell from 23.4 per cent in 2006 to 20.7 per cent, and the rate of obesity increased from 7.0 per cent in 2006 to 7.9 per cent in 2010 and remained stable from 2010 to 2014. The rate of overweight and obesity of boys was much higher than that of girls. The rate of obesity in children between 3 and 6 years increased with age, from 4.9% in the age of 3 to 11.6% in the 6-year-old, increasing by 2.4 times. The vertical study from 2013 to 2015 showed that the weight, height and BMI of boys in the three years were higher than that of the girl (P0.05), and the height of the 6-year-old boys in 2014 and 2015. The body weight was higher than that of the 5-year-old (P0.05). The height, body weight and BMI of the 6-year-old children were higher than that of the 5-year-old children (P0.05). The change of the weight of the 6-year-old children was higher than that of the 5-year-old children (P0.05). The change of the body weight of the 6-year-old children was higher than that of the 5-year-old (P0.05). The change of BMI was higher (P0.05). The difference was not significant (P0.05). The difference of obesity and overweight in children with different age in three years was not statistically significant (p0.05). The difference of obesity and overweight in different sexes in 2013 was not statistically significant (p0.05); the obesity and overweight of boys in 2014 and 2015 were higher than that of girls (p0.05). Of the 1286 children who entered the cohort in 2013,1072 were normal, the incidence of obesity was 4.6% in 2015, the incidence of overweight was 7.2%, and the total incidence of overweight or obesity was 11.8%. Logistic regression analysis showed that the time of the boy, the artificial feeding, the viewing screen (including the TV, the mobile phone, the computer) was long, The risk factors of the obesity of children between 5 and 6 years of age in the kindergartens in Tianjin are the risk factors of the obesity of children between 5 and 6 years old in Tianjin (p0.05). The degree of parental culture, the average daily sleep time, whether to eat the staple food from the children's children's home and the occurrence of obesity in the children (p0.05). The difference of abnormal rate of serum total cholesterol in children with different sex was statistically significant (p0.05), and boys were lower than that of girls. The abnormal rate of blood lipid and serum total cholesterol in children with different ages was higher than that of other age groups (p0.05). There was no statistical difference between the abnormal rate of blood lipid and the abnormal rate of serum total cholesterol (p0.05). The abnormal rate of serum triglyceride in obese children was much higher than that of normal children (p0.05). The difference of serum total cholesterol and triglyceride in children with different sex was statistically significant (p0.05), and girls were higher than that of boys. The difference of serum total cholesterol in children with different age groups was statistically significant (p0.05). There was a significant difference in serum triglyceride levels in children with different body size (p0.05). There was no significant difference in the rate of blood glucose (p0.05) among the 3-6-year-old children with different sex, age and body size. The difference of blood glucose levels between 3 and 6 years of age in different sexes was statistically significant (p0.05), and the average blood sugar level of boys was higher than that of girls. The difference of blood glucose level in children with different age groups was statistically significant (p0.05), with the increase of age and the increase of the average blood glucose level. The difference of blood glucose level in children with different body size was statistically significant (p0.05), and the average blood sugar level of obese children was higher than that of normal children. The abnormal rate of uric acid in children with different age and sex was not statistically significant (p0.05), but there was a significant difference in the rate of blood uric acid in different types of children (p0.05), and the level of obese children was higher than that of normal children. In addition, with the increase of age, the level of serum uric acid was on the rise, but there was no significant difference between the age group and the age group (p0.05). The levels of serum uric acid in children with different sex and body type were statistically significant (p0.05). The level of serum uric acid in boys was higher than that of girls, and the level of blood uric acid in obese children was higher than that of normal children. Serum total cholesterol, triglyceride, and blood uric acid were associated with the occurrence of overweight or obesity (p0.05), and there was no correlation between blood glucose and overweight or obesity (p0.05). Conclusion From 2006 to 2014, the prevalence of overweight in Tianjin from 3 to 6 years of age is generally decreasing, and the prevalence of obesity is on the rise, with the most obvious in 6-year-old children. There was a gender difference in the prevalence of overweight and obesity. The incidence of overweight and obesity in children is influenced by the interaction of time and gender. Sex male, artificial feeding, viewing screen (including television, mobile phone, computer) is long, and the time for eating is the risk factor of the obesity of children between 5 and 6 years; the mixed feeding within 4 months after birth is a protective factor for children's obesity. The level of blood lipid, blood sugar and blood uric acid in obese children was higher than that of normal children, and the level of blood glucose increased with age. The overweight and obesity of children are affected by external factors, and the prevention and health education of overweight and obesity among children aged 3 to 6 should be paid attention to, so as to reduce the prevalence of overweight and obesity of children in the age group; and the parents and the health care departments of the children shall timely monitor the physical development of the children and find out the overweight and obesity situation in time. Effective intervention is given to the particular group of children.
【学位授予单位】：天津医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R723.14
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